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DiCaro MV, Lei K, Yee B, Tak T. The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review. J Clin Med 2024; 13:3223. [PMID: 38892933 PMCID: PMC11172971 DOI: 10.3390/jcm13113223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Obstructive sleep apnea (OSA) is an increasingly relevant cause of cardiovascular morbidity worldwide. Although the association between OSA and the cardiovascular system is well-known, the extent of its effects is still a topic of interest, including pathophysiologic mechanisms, cardiovascular sequelae, and OSA therapies and their effects. Commonly described mechanisms of cardiovascular etiologies revolve around sympathetic activation, inflammation, and intermittent hypoxia resulting from OSA. Ultimately, these effects lead to manifestations in the cardiovascular system, such as arrhythmias, hypertension, and heart failure, among others. The resulting sequelae of OSA may also have differential effects based on gender and age; several studies suggest female gender to have more susceptibility to cardiovascular mortality, as well as an increase in age. Furthermore, several therapies for OSA, both established and emerging, show a reduction in cardiovascular morbidity and may even reduce cardiovascular burden. Namely, the establishment of CPAP has led to improvement in hypertension and cardiac function in patients with heart failure and even reduced the progression of early stages of atherosclerosis. Effective management of OSA decreases abnormal neural sympathetic activity, which results in better rhythm control and blood pressure control, both in waking and sleep cycles. With newer therapies for OSA, its effects on the cardiovascular system may be significantly reduced or even reversed after long-term management. The vast extent of OSA on the cardiovascular system, as well as current and future therapeutic strategies, will be described in detail in this review.
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Affiliation(s)
| | | | | | - Tahir Tak
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89102, USA; (M.V.D.); (K.L.); (B.Y.)
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2
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Di Maria J, Hartley S, Levy J, Delord V, Vaugier I, Beghadi J, Ibrahim N, Bensmail D, Prigent H, Léotard A. Adherence to continuous positive airway pressure therapy in patients with spinal cord injury and obstructive sleep apnea: trajectories and predictors. Sleep Breath 2024; 28:753-762. [PMID: 38063994 DOI: 10.1007/s11325-023-02955-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE To identify specific determinants of non-adherence or cessation of continuous positive airway pressure (CPAP) therapy in a population of patients with spinal cord injuries (SCI). METHODS Retrospective analysis of data from patients with SCI who underwent a full night supervised polysomnography between 2015 and 2021 and presented with moderate to severe obstructive sleep apnea (OSA) and for whom CPAP was indicated. Adherence was studied at 1, 6, and 12 months. Univariate and multivariate analyses were performed to identify factors associated with non-adherence (< 4 h per night or CPAP cessation). Factors studied were demographic and disease-related data and both subjective and objective sleep parameters. RESULTS A total of 60 patients were included (40% cervical SCI). In univariate analysis, the only predictive parameters of non-adherence observed at 1, 6, and 12 months were the average use of CPAP on the 1st night (p = 0.02) and over the 1st week (p ≤ 0.001). A complete lesion (AIS-A) was predictive of non-adherence at 1 and 6 months (p = 0.02 at 6 months), while mask leakage was associated with non-adherence at 12 months (p = 0.02). Upper limb autonomy and the presence of family caregivers did not appear to be protective. In multivariate analysis, only the average use in the first week remained predictive of adherence (> 4 h) in the short, medium and long term. CONCLUSION In patients with SCI and OSA, the 1st week of CPAP treatment seems to be determinant of short-, medium-, and long-term CPAP adherence. Support for SCI patients from the start of treatment is essential and may help avoid treatment failures.
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Affiliation(s)
- Julie Di Maria
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - Sarah Hartley
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France
| | - Jonathan Levy
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
- Service de médecine physique et de réadaptation, AP-HP, Hôpital Raymond Poincaré, Garches, France
- Sleep Lab Initiative In PMR group (SLIIP), Garches, France
| | | | - Isabelle Vaugier
- Centre d'investigation clinique 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Julien Beghadi
- ASV Santé, 125, Avenue Louis Roche, 92230, Gennevilliers, France
| | | | - Djamel Bensmail
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
- Service de médecine physique et de réadaptation, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Hélène Prigent
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - Antoine Léotard
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France.
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France.
- Sleep Lab Initiative In PMR group (SLIIP), Garches, France.
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3
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Facco FL, Wolsk J, Patel SR, Hubel C, Gallaher M, Cashmere JD, Wisniewski S. A trial of positive airway pressure for the treatment of sleep apnea in pregnancy. Am J Obstet Gynecol MFM 2023; 5:100840. [PMID: 36563879 DOI: 10.1016/j.ajogmf.2022.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The pathophysiology of obstructive sleep apnea in pregnancy remains poorly understood and studies examining the effect of treatment with positive airway pressure on pregnancy have been limited. OBJECTIVE This study aimed to perform a randomized controlled trial of positive airway pressure treatment for obstructive sleep apnea in pregnancy. STUDY DESIGN Participants with a body mass index ≥30 kg/m2 underwent polysomnography at 14 to 20 weeks' gestation (visit 1) and those with obstructive sleep apnea (apnea-hypopnea index ≥5 but <50) were enrolled. In phase 1, participants were randomized to autotitrating positive airway pressure vs sham positive airway pressure; in phase 2, the sham arm was replaced with a sleep hygiene control. Participants returned at 28 to 31 weeks' gestation (visit 2). The mean arterial blood pressure, uterine artery Doppler pulsatility index, endoglin, soluble FMS-like tyrosine kinase 1 levels, and placental growth factor levels were measured, as well as fasting glucose and insulin to calculate insulin resistance (homeostatic model assessment for insulin resistance). The primary outcome was a composite of the uterine artery Doppler pulsatility index, soluble FMS-like tyrosine kinase 1 to placental growth factor ratio, and the homeostatic model assessment for insulin resistance. For secondary analyses, each outcome variable was analyzed independently. Adherence to treatment was examined. RESULTS A total of 241 participants completed visit 1, and 89 (37%) had an apnea-hypopnea index between 5 and 50. Of the those, 51 participants were randomized in phase 1 and 38 in phase 2. There was no significant difference in our primary outcome by treatment group. In secondary analyses, the uterine artery Doppler pulsatility index was lower in participants on autotitrating positive airway pressure when compared with sleep hygiene controls. Otherwise, there were no differences in the mean arterial blood pressure, angiogenic markers, or metabolic markers in phase 1, phase 2, or across the entire study. The overall adherence to autotitrating positive airway pressure therapy was low, but the mean use was greater in phase 2 (0.3±0.6 hours/night vs 1.3±2.3 hours/night; P=.10). For those on active therapy, fasting glucose values decreased as adherence increased. CONCLUSION This randomized controlled trial of autotitrating positive airway pressure in pregnancy did not find any differences in a composite primary cardiometabolic risk profile between the treatment groups. Higher autotitrating positive airway pressure adherence was associated with lower fasting glucose levels. The use of a sham positive airway pressure control arm in phase1 may have negatively impacted adherence to active treatment.
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Affiliation(s)
- Francesca L Facco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA (Drs Facco and Hubel).
| | - Jennifer Wolsk
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (Ms Wolsk and Dr Wisniewski)
| | - Sanjay R Patel
- Division of Pulmonary Allergy and Critical Care Medicine, Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA (Dr Patel)
| | - Carl Hubel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA (Drs Facco and Hubel); Magee-Womens Research Institute, Pittsburgh, PA (Dr Hubel and Ms Gallaher)
| | - Marcia Gallaher
- Magee-Womens Research Institute, Pittsburgh, PA (Dr Hubel and Ms Gallaher)
| | - J David Cashmere
- University of Pittsburgh Medical Center, Pittsburgh, PA (Mr Cashmere)
| | - Stephen Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (Ms Wolsk and Dr Wisniewski)
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May AM, Patel SR, Yamauchi M, Verma TK, Weaver TE, Chai-Coetzer CL, Thornton JD, Ewart G, Showers T, Ayas NT, Parthasarathy S, Mehra R, Billings ME. Moving toward Equitable Care for Sleep Apnea in the United States: Positive Airway Pressure Adherence Thresholds: An Official American Thoracic Society Policy Statement. Am J Respir Crit Care Med 2023; 207:244-254. [PMID: 36722719 PMCID: PMC9896653 DOI: 10.1164/rccm.202210-1846st] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. Methods: An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. Results: In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Conclusions: Modifications to the current policies for PAP insurance coverage could improve health disparities.
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Hirani R, Smiley A. A Scoping Review of Sleep Apnea: Where Do We Stand? Life (Basel) 2023; 13:life13020387. [PMID: 36836743 PMCID: PMC9961756 DOI: 10.3390/life13020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Obstructive sleep apnea (OSA), a condition in which there is a recurrent collapse of the upper airway while sleeping, is a widespread disease affecting 5% to 10% people worldwide. Despite several advances in the treatment modalities for OSA, morbidity and mortality remain a concern. Common symptoms include loud snoring, gasping for air during sleep, morning headache, insomnia, hypersomnia, attention deficits, and irritability. Obese individuals, male gender, older age (65+), family history, smoking, and alcohol consumption are well recognized risk factors of OSA. This condition holds the ability to increase inflammatory cytokines, cause metabolic dysfunction, and increase the sympathetic output, all of which exacerbate OSA due to their effect on the cardiovascular system. In this review, we discuss its brief history, risk factors, complications, treatment modalities, and the role of clinicians in curbing its risk.
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Affiliation(s)
- Rahim Hirani
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Department of Surgery, Westchester Medical Center, New York, NY 10595, USA
| | - Abbas Smiley
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Department of Surgery, Westchester Medical Center, New York, NY 10595, USA
- Correspondence:
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Pataka A, Kotoulas SC, Gavrilis PR, Karkala A, Tzinas A, Stefanidou A. Adherence to CPAP Treatment: Can Mindfulness Play a Role? Life (Basel) 2023; 13:life13020296. [PMID: 36836653 PMCID: PMC9960813 DOI: 10.3390/life13020296] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Obstructive sleep apnea (OSA) is considered a chronic disease that requires long-term multidisciplinary management for effective treatment. Continuous Positive Airway Pressure (CPAP) is still considered the gold standard of therapy. However, CPAP effectiveness is limited due to poor patients' adherence, as almost 50% of patients discontinue treatment after a year. Several interventions have been used in order to increase CPAP adherence. Mindfulness-based therapies have been applied in other sleep disorders such as insomnia but little evidence exists for their application on OSA patients. This review aims to focus on the current data on whether mindfulness interventions may be used in order to increase CPAP adherence and improve the sleep quality of OSA patients. Even though controlled trials of mindfulness and CPAP compliance remain to be performed, this review supports the hypothesis that mindfulness may be used as an adjunct method in order to increase CPAP adherence in OSA patients.
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Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
- Correspondence:
| | | | | | - Alice Karkala
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Asterios Tzinas
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Aimiliza Stefanidou
- American College of Thessaloniki (ACT), Vasiliou Sevenidi 17, Pilea, 55535 Thessaloniki, Greece
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7
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Genzor S, Prasko J, Mizera J, Jakubec P, Sova M, Vanek J, Šurinová N, Langova K. Risk of Severe COVID-19 in Non-Adherent OSA Patients. Patient Prefer Adherence 2022; 16:3069-3079. [PMID: 36387050 PMCID: PMC9657257 DOI: 10.2147/ppa.s387657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients with obstructive sleep apnoea (OSA) are at increased risk of severe course of COVID-19. Vaccination remains to be the most effective prevention of complicated courses of infection. The best contemporary conservative treatment of OSA is continuous positive airway pressure (CPAP) therapy. Purpose To compare vaccination acceptance and outcomes of COVID-19 infection between OSA patients adhering to the CPAP therapy and those who rejected CPAP and surgical therapy. Patients and Methods Subjects were divided into two groups: group A (N = 167) were individuals with sufficient CPAP adherence (more than 4 hours per night on average) over the last 10 years. Group B (N = 106) were individuals who did not use the CPAP therapy at all and had no indications to surgical therapy. Results Three patients in group B died, and one had a severe course of COVID-19. None of the patients in group A died or experienced a severe course of COVID-19. Group A had a significantly higher proportion of males (77.8% compared to 66% in group B) and all parameters of OSA severity. The vaccination status was similar among both groups, with a complete triple dose vaccination rate of 69.5% and 67.9% in groups A and B, respectively. Conclusion The results show that the patients with OSA adherent to CPAP therapy were less likely to experience a severe course of COVID-19 or death than the OSA patients non-compliant with therapy, despite the former group having more severe OSA. This result underlines the importance of adherence to CPAP therapy in OSA.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, OlomoucCzech Republic
- Institute for Postgraduate Education in Health Care, PragueCzech Republic
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, NitraThe Slovak Republic
| | - Jan Mizera
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Petr Jakubec
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Milan Sova
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Masaryk University Brno and University Hospital Brno, BrnoCzech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, OlomoucCzech Republic
| | | | - Katerina Langova
- Department of Biophysics, Palacky University Olomouc, OlomoucCzech Republic
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Frange C, Franco AM, Brasil E, Hirata RP, Lino JA, Mortari DM, Ykeda DS, Leocádio-Miguel MA, D’Aurea CVR, Silva LOE, Telles SCL, Furlan SF, Peruchi BB, Leite CF, Yagihara FT, Campos LD, Ulhôa MA, Cruz MGDR, Beidacki R, Santos RB, de Queiroz SS, Barreto S, Piccin VS, Coelho FMS, Studart L, Assis M, Drager LF. Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines. Sleep Sci 2022; 15:515-573. [PMID: 36419815 PMCID: PMC9670776 DOI: 10.5935/1984-0063.20220083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 08/13/2024] Open
Abstract
This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.
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Affiliation(s)
- Cristina Frange
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
| | - Aline Marques Franco
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Neurociências e Ciências do
Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de
São Paulo (FMRP-USP) - Ribeirão Preto - SP - Brazil
| | - Evelyn Brasil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Terapia Intensiva, Hospital Israelita Albert
Einstein (HIAE) - São Paulo - SP - Brazil
| | - Raquel Pastrello Hirata
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Pesquisa em Fisioterapia Pulmonar,
Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL) - Londrina -
PR - Brazil
| | - Juliana Arcanjo Lino
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Ciências Médicas, Universidade Federal do
Ceará (UFC) - Fortaleza - CE - Brazil
| | - Daiana Moreira Mortari
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal do Rio Grande do Sul - Porto Alegre - RS -
Brazil
| | - Daisy Satomi Ykeda
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Curso de Fisioterapia, Universidade Estadual do Piauí
(UESPI) - Teresina - PI - Brazil
| | - Mario André Leocádio-Miguel
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisiologia e Comportamento, Universidade Federal do
Rio Grande do Norte - Natal - RN - Brazil
| | | | - Luciana Oliveira e Silva
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Ciências da Saúde, Universidade
Federal de Uberlândia (UFU) - Uberlândia - MG - Brazil
| | | | - Sofia Fontanello Furlan
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
| | - Bruno Búrigo Peruchi
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Neurociência, Universidade do Estado
de Santa Catarina (UNESC) - Criciúma - SC - Brazil
| | - Camila Ferreira Leite
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, UFC; Programas de Mestrado em
Fisioterapia e Funcionalidade, e Mestrado em Ciências Cardiovasculares, UFC -
Fortaleza - CE - Brazil
| | - Fabiana Tokie Yagihara
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Setor de Neurofisiologia Clínica, Departamento de
Neurologia e Neurocirurgia, EPM, UNIFESP - São Paulo - SP - Brazil
| | | | - Melissa Araújo Ulhôa
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto Metropolitano de Ensino Superior, Faculdade de Medicina
do Vale do Aço (UNIVAÇO) - Ipatinga - MG - Brazil
| | | | - Ricardo Beidacki
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Faculdade Inspirar, Unidade Porto Alegre - Porto Alegre - RS -
Brazil
| | - Ronaldo Batista Santos
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, Hospital Universitário, USP -
São Paulo - Brazil
| | | | - Simone Barreto
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto do Sono, Associação Fundo Incentivo
à Pesquisa - São Paulo - Brazil
| | - Vivien Schmeling Piccin
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório do Sono, Divisão de Pneumologia do
Instituto do Coração (InCor), FMUSP, USP - São Paulo - SP -
Brazil
| | - Fernando Morgadinho Santos Coelho
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Psicobiologia, EPM, UNIFESP - São Paulo -
SP - Brazil
| | - Luciana Studart
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal de Pernambuco - Recife - PE - Brazil
| | - Marcia Assis
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Clínica do Sono de Curitiba, Hospital São Lucas -
Curitiba - PR - Brazil
| | - Luciano F. Drager
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
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Taweesedt P, Najeeb H, Surani S. Patient-Centered Therapy for Obstructive Sleep Apnea: A Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1338. [PMID: 36295499 PMCID: PMC9612386 DOI: 10.3390/medicina58101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common sleep problems defined by cessation or decreased airflow despite breathing efforts. It is known to be related to multiple adverse health consequences. Positive airway pressure (PAP) is considered an effective treatment that is widely used. Various modes of PAP and other emerging treatment options are now available. A multidisciplinary approach, understanding diverse phenotypes of OSA, and shared decision-making are necessary for successful OSA treatment. Patient-centered care is an essential modality to support patient care that can be utilized in patients with OSA to help improve outcomes, treatment adherence, and patient satisfaction.
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Affiliation(s)
| | - Hala Najeeb
- Dow Medical College, Dow University of Health Science, Karachi 74200, Pakistan
| | - Salim Surani
- Health Science Center, Texas A&M University, College Station, TX 79016, USA
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10
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Duan N, Norman D, Schmid C, Sim I, Kravitz RL. Personalized Data Science and Personalized (N-of-1) Trials: Promising Paradigms for Individualized Health Care. HARVARD DATA SCIENCE REVIEW 2022; 4:10.1162/99608f92.8439a336. [PMID: 38009133 PMCID: PMC10673628 DOI: 10.1162/99608f92.8439a336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
The term 'data science' usually refers to the process of extracting value from big data obtained from a large group of individuals. An alternative rendition, which we call personalized data science (Per-DS), aims to collect, analyze, and interpret personal data to inform personal decisions. This article describes the main features of Per-DS, and reviews its current state and future outlook. A Per-DS investigation is of, by, and for an individual, the Per-DS investigator, acting simultaneously as her own investigator, study participant, and beneficiary, and making personalized decisions for study design and implementation. The scope of Per-DS studies may include systematic monitoring of physiological or behavioral patterns, case-crossover studies for symptom triggers, pre-post trials for exposure-outcome relationships, and personalized (N-of-1) trials for effectiveness. Per-DS studies produce personal knowledge generalizable to the individual's future self (thus benefiting herself) rather than knowledge generalizable to an external population (thus benefiting others). This endeavor requires a pivot from data mining or extraction to data gardening, analogous to home gardeners producing food for home consumption-the Per-DS investigator needs to 'cultivate the field' by setting goals, specifying study design, identifying necessary data elements, and assembling instruments and tools for data collection. Then, she can implement the study protocol, harvest her personal data, and mine the data to extract personal knowledge. To facilitate Per-DS studies, Per-DS investigators need support from community-based, scientific, philanthropic, business, and government entities, to develop and deploy resources such as peer forums, mobile apps, 'virtual field guides,' and scientific and regulatory guidance.
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Affiliation(s)
- Naihua Duan
- Department of Psychiatry, Columbia University, New York, NY)
| | - Daniel Norman
- Santa Monica Sleep Disorders Center, Los Angeles, CA
| | | | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, CA
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